Centre for Addiction and Mental Health (Kurdyak, Zaheer, Carvalho, de Oliveira, Stergiopoulos, Mulsant); Department of Psychiatry (Zaheer, Carvalho, Fefergrad, Stergiopoulos, Mulsant) and Institute for Health Policy, Management and Evaluation (de Oliveira), Faculty of Medicine, University of Toronto; ICES (Kurdyak, Lebenbaum, Wilton), Toronto, Ont.
CMAJ Open. 2020 Mar 10;8(1):E105-E115. doi: 10.9778/cmajo.20190094. Print 2020 Jan-Mar.
Psychotherapy is recommended as a first-line treatment for the management of common psychiatric disorders. The objective of this study was to evaluate the availability of publicly funded psychotherapy provided by physicians in Ontario by describing primary care physicians (PCPs) and psychiatrists whose practices focus on psychotherapy and comparing them to PCPs and psychiatrists whose practices do not.
This was a population-based retrospective cohort study. We included all PCPs and psychiatrists in Ontario who submitted at least 1 billing claim to the Ontario Health Insurance Plan between Apr. 1, 2015, and Mar. 31, 2016, and categorized them as psychotherapists if at least 50% of their outpatient billings were related to the provision of psychotherapy. We measured practice characteristics such as total number of patients and new patients, and average visit frequency for 4 physician categories: PCP nonpsychotherapists, PCP psychotherapists, psychiatrist nonpsychotherapists and psychiatrist psychotherapists. We also measured access to care for people with urgent need for mental health services.
Of 12 772 PCPs, 404 (3.2%) were PCP psychotherapists; of 2150 psychiatrists, 586 (27.3%) were psychotherapists. Primary care physician nonpsychotherapists had the highest number of patients and number of new patients, followed by psychiatrist nonpsychotherapists, PCP psychotherapists and psychiatrist psychotherapists. Primary care physician nonpsychotherapists had the lowest average annual number of visits per patient, whereas both types of psychotherapists had a much greater number of visits per patient. Primary care physician and psychiatrist nonpsychotherapists saw about 25% of patients with urgent needs for mental health services, whereas PCP and psychiatrist psychotherapists saw 1%-3% of these patients.
Physicians who provide publicly funded psychotherapy in Ontario see a small number of patients, and they see few of those with urgent need for mental health services. Our findings suggest that improving access to psychotherapy will require the development of alternative strategies.
心理治疗被推荐为常见精神疾病管理的一线治疗方法。本研究的目的是通过描述专注于心理治疗的初级保健医生（PCP）和精神科医生，并将其与不专注于心理治疗的 PCP 和精神科医生进行比较，来评估安大略省由医生提供的公共资金心理治疗的可及性。
这是一项基于人群的回顾性队列研究。我们纳入了所有在 2015 年 4 月 1 日至 2016 年 3 月 31 日期间向安大略省健康保险计划提交至少 1 次计费索赔的 PCP 和精神科医生，如果他们的门诊计费中有至少 50%与提供心理治疗有关，则将其归类为心理治疗师。我们测量了实践特征，如 4 种医生类别的总患者人数和新患者人数，以及平均就诊频率：非心理治疗师的 PCP、心理治疗师的 PCP、非心理治疗师的精神科医生和心理治疗师的精神科医生。我们还衡量了有紧急心理健康服务需求的人的获得护理情况。
在 12772 名 PCP 中，有 404 名（3.2%）是 PCP 心理治疗师；在 2150 名精神科医生中，有 586 名（27.3%）是心理治疗师。非心理治疗师的 PCP 有最多的患者和新患者，其次是非心理治疗师的精神科医生、心理治疗师的 PCP 和心理治疗师的精神科医生。非心理治疗师的 PCP 每位患者的平均年就诊次数最少，而这两种类型的心理治疗师每位患者的就诊次数都要多得多。非心理治疗师的 PCP 和精神科医生约有 25%的患者有紧急心理健康服务需求，而心理治疗师的 PCP 和精神科医生只有 1%-3%的患者有紧急心理健康服务需求。
在安大略省提供公共资金心理治疗的医生只看诊少数患者，并且他们看诊的患者中很少有紧急心理健康服务需求的患者。我们的研究结果表明，要改善心理治疗的可及性，需要制定替代策略。
